Comparison of Balloon Guide Catheters and Standard Guide Catheters for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

医学 改良兰金量表 脑出血 优势比 荟萃分析 置信区间 溶栓 冲程(发动机) 外科 血运重建 闭塞 内科学 格拉斯哥昏迷指数 缺血性中风 心肌梗塞 缺血 工程类 机械工程
作者
John M. Pederson,Natalie L. Reierson,Nicole Hardy,Jillienne C. Touchette,Sammy Medam,Averi Barrett,Megan Schmidt,Waleed Brinjikji,David F. Kallmes,Kevin M. Kallmes
出处
期刊:World Neurosurgery [Elsevier BV]
卷期号:154: 144-153.e21 被引量:38
标识
DOI:10.1016/j.wneu.2021.07.034
摘要

Balloon guide catheters (BGCs) are designed to induce flow arrest during mechanical thrombectomy procedures for acute ischemic stroke due to large-vessel occlusion and have been associated with improved clinical and angiographic outcomes. We conducted a systematic review and meta-analysis evaluating the relative technical and clinical outcomes associated with BGC versus non-BGC approaches.A systematic review of clinical literature using the PubMed database was undertaken to identify multiarm studies published between 2010 and 2021 reporting the use of BGC versus non-BGC approaches for stroke treatment. Data collected included complete recanalization (thrombolysis in cerebral infarction, TICI), first-pass effect TICI 3, puncture-to recanalization time, number of endovascular attempts, distal embolization, symptomatic intracerebral hemorrhage, 90-day modified Rankin Scale score 0-2, and 90-day mortality. Subgroup analyses assessed the impact of treatment device (stent-retrievers, contact aspiration, combination therapy, and not specified/other). A random effects model was fit for each outcome measure.Fifteen studies were included. Compared with non-BGC approaches, patients treated with BGCs had greater odds of TICI 3 (odds ratio [OR] 1.57; 95% confidence interval [95% CI] 1.08-2.29) and first-pass effect TICI 3 (OR 3.63; 95% CI 2.34-5.62), reduced puncture-to-revascularization time (mean difference -7.8; 95% CI -13.3 to -2.2), fewer endovascular attempts (mean difference -0.47; 95% CI -0.68 to -0.26), reduced odds of distal emboli (OR 0.34; 95% CI 0.17-0.71) and symptomatic intracerebral hemorrhage (OR 0.66; 95% CI 0.51-0.86), greater odds of 90-day modified Rankin Scale score 0-2 (OR 1.51; 95% CI 1.27-1.79), and reduced odds of mortality (OR 0.69; 95% CI 0.57-0.82).BGCs yield superior technical and clinical outcomes while reducing patient complications.
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